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Li J, Zhao T, Sun Y. Interleukin-17A in diabetic retinopathy: The crosstalk of inflammation and angiogenesis. Biochem Pharmacol 2024; 225:116311. [PMID: 38788958 DOI: 10.1016/j.bcp.2024.116311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
Diabetic retinopathy (DR) is a severe ocular complication of diabetes which can leads to irreversible vision loss in its late-stage. Chronic inflammation results from long-term hyperglycemia contributes to the pathogenesis and progression of DR. In recent years, the interleukin-17 (IL-17) family have attracted the interest of researchers. IL-17A is the most widely explored cytokine in IL-17 family, involved in various acute and chronic inflammatory diseases. Growing body of evidence indicate the role of IL-17A in the pathogenesis of DR. However, the pro-inflammatory and pro-angiogenic effect of IL-17A in DR have not hitherto been reviewed. Gaining an understanding of the pro-inflammatory role of IL-17A, and how IL-17A control/impact angiogenesis pathways in the eye will deepen our understanding of how IL-17A contributes to DR pathogenesis. Herein, we aimed to thoroughly review the pro-inflammatory role of IL-17A in DR, with focus in how IL-17A impact inflammation and angiogenesis crosstalk.
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Affiliation(s)
- Jiani Li
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Tantai Zhao
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China
| | - Yun Sun
- Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan, China.
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Barańska-Rybak W, Świerczewska Z, Lemiec A, Walker L. Triamcinolone Injection in the Treatment of Malar Edema. Dermatol Pract Concept 2024; 14:dpc.1402a117. [PMID: 38810029 PMCID: PMC11136127 DOI: 10.5826/dpc.1402a117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Tear-through deformities can be a detectable sign of facial aging. Over recent years, minimally invasive procedures such as hyaluronic acid filler injections have been shown to be effective in improving this area. Malar edema is the accumulation of fluid over the malar eminence persisting for 1 month or more. Given its nature, the management remains problematic. The most commonly reported treatment modality is injection with hyaluronidase. OBJECTIVES To determine the safety and efficacy of triamcinolone injection in the treatment of malar edema. METHODS A total of 15 female patients with malar edema, with a mean age of 43.77 years, were treated with triamcinolone injections. The volume injected was chosen by the investigator. Prior to the triamcinolone injection, all patients had been treated with hyaluronidase, which turned out to be ineffective in all cases. Patients were asked to note all adverse effects. RESULTS Satisfactory results were achieved after a single treatment session for 14 patients and after two treatments for one patient. Overall, injections with triamcinolone were well tolerated and no adverse reactions were reported. CONCLUSIONS Injection with triamcinolone appears to be a safe and effective option for the management of malar edema following hyaluronic acid filler injection. Nevertheless, further research with larger patient groups is compulsory.
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Affiliation(s)
- Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Zuzanna Świerczewska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Poland
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Simona F, Menna F, Wannesson L, Meduri A, De Salvo G, Querques G. Lurbinectedin improves macular edema in a case of central retinal vein occlusion. Am J Ophthalmol Case Rep 2022; 28:101743. [DOI: 10.1016/j.ajoc.2022.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/23/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022] Open
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Kishore K, Bhat PV, Venkatesh P, Canizela CC. Dexamethasone Intravitreal Implant for the Treatment of Macular Edema and Uveitis: A Comprehensive Narrative Review. Clin Ophthalmol 2022; 16:1019-1045. [PMID: 35418744 PMCID: PMC8995179 DOI: 10.2147/opth.s209395] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/10/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose The purpose of this review article is to provide a comprehensive review of the current applications of intravitreal DEX implant (Ozurdex®, Allergan Inc, Irvine, CA) for a variety of ophthalmic conditions – ranging from FDA approved indications to off-label uses. We have attempted to provide relevant evidence from the literature to help a reader develop an understanding of the biological and pharmacokinetic properties of DEX implant, its uses, and potential side effects. Methods PubMed searches were performed using the terms “Ozurdex”, or “intravitreal DEX implant”, AND “retinal vein occlusion”, or “diabetic macular edema”, or “uveitis”. The search was performed in July of 2021, with an additional search in October 2021. All original English language articles were considered for this review. Results DEX implant has evidence of efficacy in a variety of clinical situations including macular edema associated with retinal vein occlusion, diabetes, uveitis, and others. Safety concerns include cataract formation and progression, intraocular pressure elevation, complications related to intravitreal injection, and opportunistic infections secondary to steroid-induced immune suppression. Conclusion DEX implant is a useful tool in the management of several retinal disorders. Further studies are needed for head-to-head comparison with other treatment modalities and to determine its precise place in clinical practice.
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Affiliation(s)
- Kamal Kishore
- Illinois Retina and Eye Associates, Peoria, IL, USA
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
- Correspondence: Kamal Kishore, Illinois Retina and Eye Associates, 4505 N Rockwood Drive, Suite 1, Peoria, IL, 61615, USA, Tel +1 3095891880, Fax +1 3095891885, Email
| | - Pooja V Bhat
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Pradeep Venkatesh
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, 110029, India
| | - Cecilia C Canizela
- Department of Surgery, University of Illinois College of Medicine, Peoria, IL, USA
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Fernandes AR, Dos Santos T, Granja PL, Sanchez-Lopez E, Garcia ML, Silva AM, Souto EB. Permeability, anti-inflammatory and anti-VEGF profiles of steroidal-loaded cationic nanoemulsions in retinal pigment epithelial cells under oxidative stress. Int J Pharm 2022; 617:121615. [PMID: 35217072 DOI: 10.1016/j.ijpharm.2022.121615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 02/08/2022] [Accepted: 02/20/2022] [Indexed: 12/19/2022]
Abstract
Age-related macular degeneration (AMD) is defined as a degenerative, progressive and multifactorial disorder that affects the macula with a complex etiology. The retinal pigment epithelium is a monolayer of cells that has the function to separate the surface of the choroid from the neural retina that is involved in the signal transduction leading to vision. The blood-aqueous barrier and the blood retinal barrier limit the permeation of drugs into the retina and thereby reducing their efficacy. Triamcinolone acetonide (TA) is widely used as anti-inflammatory and immunomodulatory drug that promotes the inhibition of the inflammatory processes. The factors that stimulate or inhibit angiogenesis in AMD create a local balance that is responsible for the growth of sub-retinal neovascularization. In AMD, the main angiogenic stimulus is the vascular endothelial growth factor (VEGF). In this work, nanoemulsions with cationic surfactants (mono- and dicationic DABCO and quinuclidine) were produced to deliver TA, and were found to reduce the production of tumor necrosis factor alpha (TNF-α), which stimulates the choroidal neovascularization development by upregulating the VEGF production, and consequently decreased the VEGF levels. Our results support the potential use of mono- and dicationic DABCO and quinuclidine-based cationic nanoemulsions for the delivery of TA in the treatment of AMD.
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Affiliation(s)
- Ana R Fernandes
- i3S - Institute for Research & Innovation in Health, University of Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal; INEB - Biomedical Engineering National Institute, University of Porto, Alfredo Allen 208, 4200-135 Porto, Portugal; Faculty of Engineering, University of Porto, R. Dr. Roberto Frias, 4200-465 Porto, Portugal; Centre for Research and Technology of Agro-Environmental and Biological Sciences, CITAB, UTAD, Quinta de Prados, P-5001-801 Vila Real, Portugal; Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Tiago Dos Santos
- i3S - Institute for Research & Innovation in Health, University of Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal; INEB - Biomedical Engineering National Institute, University of Porto, Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Pedro L Granja
- i3S - Institute for Research & Innovation in Health, University of Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal; INEB - Biomedical Engineering National Institute, University of Porto, Alfredo Allen 208, 4200-135 Porto, Portugal
| | - Elena Sanchez-Lopez
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN2UB), University of Barcelona, Barcelona, Spain
| | - Maria L Garcia
- Centre for Research and Technology of Agro-Environmental and Biological Sciences, CITAB, UTAD, Quinta de Prados, P-5001-801 Vila Real, Portugal; Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, Faculty of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Amelia M Silva
- Centre for Research and Technology of Agro-Environmental and Biological Sciences, CITAB, UTAD, Quinta de Prados, P-5001-801 Vila Real, Portugal; Department of Biology and Environment, University of Trás-os-Montes e Alto Douro, UTAD, Quinta de Prados, P-5001-801 Vila Real, Portugal.
| | - Eliana B Souto
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; CEB - Centre of Biological Engineering, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga, Guimarães, Portugal.
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Hsiao CC, Chang YC, Hsiao YT, Chen PH, Hsieh MC, Wu WC, Kao YH. Triamcinolone acetonide modulates TGF‑β2‑induced angiogenic and tissue‑remodeling effects in cultured human retinal pigment epithelial cells. Mol Med Rep 2021; 24:802. [PMID: 34523693 PMCID: PMC8456346 DOI: 10.3892/mmr.2021.12442] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 08/31/2021] [Indexed: 12/17/2022] Open
Abstract
Transforming growth factor-β2 (TGF-β2) has been implicated in the pathogenesis of proliferative vitreoretinopathy (PVR) and proliferative diabetic retinopathy (PDR), due to its ability to stimulate the overproduction of pro-angiogenic factors, such as vascular endothelial growth factor (VEGF), and remodeling of the extracellular matrix (ECM). Although intravitreal triamcinolone acetonide (TA) is clinically useful in the treatment of PVR and PDR, its molecular mechanism has yet to be fully elucidated. The present study investigated whether TA treatment altered TGF-β2-driven biological effects on the behavior of cultured human retinal pigment epithelial (RPE) cells, in order to determine which signaling pathway may be essential for the pharmacological action of TA. The R-50 human RPE cell line was treated with TA in the presence of TGF-β2, followed by analyses of cell viability and contraction using cell viability and collagen gel contraction assays. VEGF mRNA expression and protein production were measured using reverse transcription-quantitative PCR and ELISA, respectively. The phosphorylation status of signaling mediators and the protein expression of type I collagen (COL1A1), α-smooth muscle actin (α-SMA), and ECM-remodeling enzymes, including MMP-2 and MMP-9, were analyzed using western blotting. The gelatinolytic activity of MMPs was detected using gelatin zymography. TA treatment exhibited no prominent cytotoxicity but markedly antagonized TGF-β2-induced cytostatic effects on RPE cell viability and TGF-β2-enhanced contractility in collagen gels. In the context of TGF-β2-related signaling, TA significantly attenuated TGF-β2-elicited Smad2, extracellular-regulated kinase (ERK)1/2 and p38 mitogen-activated protein kinase (MAPK) phosphorylation. Moreover, TA markedly mitigated TGF-β2-induced VEGF upregulation through ablation of p38 signaling activity. TA also partially attenuated TGF-β2-elicted expression of COL1A1, α-SMA, MMP-2, and MMP-9, but only suppressed TGF-β2-induced MMP-9 gelatinolytic activity. Mechanistically, the MEK/ERK signaling pathway may have a critical role in the TGF-β2-induced upregulation of COL1A1, α-SMA and MMP-9. In conclusion, TA may be considered a useful therapeutic agent for treating TGF-β2-associated intraocular angiogenesis and tissue remodeling, the underlying mechanism of which may involve the ERK and p38 MAPK signaling pathways.
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Affiliation(s)
- Chih-Cheng Hsiao
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan, R.O.C
| | - Yo-Chen Chang
- Department of Ophthalmology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan, R.O.C
| | - Yu-Ting Hsiao
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan, R.O.C
| | - Po-Han Chen
- Department of Medical Research, E‑Da Hospital, Kaohsiung 82445, Taiwan, R.O.C
| | - Ming-Chu Hsieh
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80761, Taiwan, R.O.C
| | - Wen-Chuan Wu
- Department of Ophthalmology, China Medical University Hospital, Taichung 404332, Taiwan, R.O.C
| | - Ying-Hsien Kao
- Department of Medical Research, E‑Da Hospital, Kaohsiung 82445, Taiwan, R.O.C
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Martins B, Amorim M, Reis F, Ambrósio AF, Fernandes R. Extracellular Vesicles and MicroRNA: Putative Role in Diagnosis and Treatment of Diabetic Retinopathy. Antioxidants (Basel) 2020; 9:E705. [PMID: 32759750 PMCID: PMC7463887 DOI: 10.3390/antiox9080705] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/01/2020] [Accepted: 08/02/2020] [Indexed: 02/07/2023] Open
Abstract
Diabetic retinopathy (DR) is a complex, progressive, and heterogenous retinal degenerative disease associated with diabetes duration. It is characterized by glial, neural, and microvascular dysfunction, being the blood-retinal barrier (BRB) breakdown a hallmark of the early stages. In advanced stages, there is formation of new blood vessels, which are fragile and prone to leaking. This disease, if left untreated, may result in severe vision loss and eventually legal blindness. Although there are some available treatment options for DR, most of them are targeted to the advanced stages of the disease, have some adverse effects, and many patients do not adequately respond to the treatment, which demands further research. Oxidative stress and low-grade inflammation are closely associated processes that play a critical role in the development of DR. Retinal cells communicate with each other or with another one, using cell junctions, adhesion contacts, and secreted soluble factors that can act in neighboring or long-distance cells. Another mechanism of cell communication is via secreted extracellular vesicles (EVs), through exchange of material. Here, we review the current knowledge on deregulation of cell-to-cell communication through EVs, discussing the changes in miRNA expression profiling in body fluids and their role in the development of DR. Thereafter, current and promising therapeutic agents for preventing the progression of DR will be discussed.
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Affiliation(s)
- Beatriz Martins
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (B.M.); (M.A.); (F.R.); (A.F.A.)
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Madania Amorim
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (B.M.); (M.A.); (F.R.); (A.F.A.)
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Flávio Reis
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (B.M.); (M.A.); (F.R.); (A.F.A.)
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3000-548 Coimbra, Portugal
| | - António Francisco Ambrósio
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (B.M.); (M.A.); (F.R.); (A.F.A.)
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3000-548 Coimbra, Portugal
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), 3000-548 Coimbra, Portugal
| | - Rosa Fernandes
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal; (B.M.); (M.A.); (F.R.); (A.F.A.)
- Center for Innovative Biomedicine and Biotechnology, University of Coimbra, 3000-548 Coimbra, Portugal
- Association for Innovation and Biomedical Research on Light and Image (AIBILI), 3000-548 Coimbra, Portugal
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Kelley RA, Ghaffari A, Wang Y, Choi S, Taylor JR, Hartman RR, Kompella UB. Manufacturing of Dexamethasone-Poly(d,l-Lactide-co-Glycolide) Implants Using Hot-Melt Extrusion: Within- and Between-Batch Product Performance Comparisons. J Ocul Pharmacol Ther 2020; 36:290-297. [PMID: 32330403 DOI: 10.1089/jop.2019.0074] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose: Reliable drug therapy with injectable intravitreal implants requires implants of consistent quality. The purpose of this study was to prepare dexamethasone-poly(d,l-lactide-co-glycolide) (PLGA) biodegradable implants and assess implant quality within and between batches for different polymer compositions. Methods: Implants containing 20% w/w dexamethasone with 3 theoretical rates of release (fast, intermediate, and slow) were manufactured with decreasing proportion of acid-terminated PLGA (50:50) and increasing proportion of ester-terminated PLGA (50:50) in a batch process using hot-melt extrusion. The implants were manufactured without and with in-process modification of extrusion/conveyor speed in the late phase of each batch. Implant samples collected at early, middle, and late phases of each batch were analyzed for diameter, drug loading, mechanical properties (strength and toughness), and drug release. Results: With a fixed process, unlike a modified process with an increase in extrusion speed and reduction of conveyor speed in the late phase, all implant formulations tended to decrease in diameter and mechanical properties in the late phase. Drug release profiles for the intermediate and slow release compositions were similar with or without process modification, unlike the fast release composition. Addition of ester-terminated PLGA resulted in a slower drug release. When all formulations are grouped together, the implant diameter exhibited a moderate correlation with mechanical properties, but no correlation was observed with drug release. Conclusions: Within a hot-melt extrusion batch process, the dexamethasone-PLGA implant diameter and hence toughness and strength tend to decline in the latter phase. In-process adjustment of extrusion and conveyor speeds can improve batch consistency and, potentially, implant integrity or performance during or after injection. Process changes did not affect drug release for 2 of the 3 implant compositions.
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Affiliation(s)
- Ryan A Kelley
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alireza Ghaffari
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Yan Wang
- Food and Drug Administration, White Oak Campus, Silver Spring, Maryland
| | - Stephanie Choi
- Food and Drug Administration, White Oak Campus, Silver Spring, Maryland
| | - Jonathan R Taylor
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rachel R Hartman
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Uday B Kompella
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Semeraro F, Morescalchi F, Cancarini A, Russo A, Rezzola S, Costagliola C. Diabetic retinopathy, a vascular and inflammatory disease: Therapeutic implications. DIABETES & METABOLISM 2019; 45:517-527. [PMID: 31005756 DOI: 10.1016/j.diabet.2019.04.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 12/13/2022]
Abstract
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes and the leading cause of visual impairment in the working-age population in the Western world. Diabetic macular oedema (DME) is one of the major complications of DR. Therapy with intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs has become the gold standard treatment for DR and its complications. However, these drugs have no effect on the pathogenesis of DR and must be administered frequently via invasive intravitreal injections over many years. Thus, there is a pressing need to develop new therapeutic strategies to improve the treatment of this devastating disease. Indeed, an increasing volume of data supports the role of the inflammatory process in the pathogenesis of DR itself and its complications, including both increased retinal vascular permeability and neovascularization. Inflammation may also contribute to retinal neurodegeneration. Evidence that low-grade inflammation plays a critical role in the pathogenesis of DME has opened up new pathways and targets for the development of improved treatments. Anti-inflammatory compounds such as intravitreal glucocorticoids, topical non-steroidal anti-inflammatory drugs (NSAIDs), antioxidants, inflammatory molecule inhibitors, renin-angiotensin system (RAS) blockers and natural anti-inflammatory therapies may all be considered to reduce the rate of administration of antineovascularization agents in the treatment of DR. This report describes the current state of knowledge of the potential role of anti-inflammatory drugs in controlling the onset and evolution of DR and DME.
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Affiliation(s)
- F Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
| | - F Morescalchi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
| | - A Cancarini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
| | - A Russo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
| | - S Rezzola
- Department of Molecular and Translational Medicine, University of Brescia, Viale Europa 11, 25123 Brescia, Italy.
| | - C Costagliola
- Department of Medicine and Health Sciences 'V. Tiberio', University of Molise, Via Francesco De Sanctis 1, 86100 Campobasso, Italy.
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10
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Dogan C, Yetik H, Arslan OS, Seymen HO, Suzer O, Aydin O, Mergen B. The safety of intraocular usage of aspirin. Cutan Ocul Toxicol 2019; 38:201-205. [PMID: 30719931 DOI: 10.1080/15569527.2019.1575391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To determine the effects of intravitreally injected aspirin on normal ocular tissues. METHODS Six eyes of 3 rabbits as a control group, 18 eyes of 9 albino rabbits which were injected aspirin intravitreally were studied. In the control group, the same volume of balanced salt solution (BSS) as in drug groups were injected. Clinical examination methods including biomicroscopy, indirect ophthalmoscopy, and Schiotz tonometry, electrophysiological test including ERG, and histopathological examination including light microscopy were used to evaluate the ocular effects after drug injections. All the study tests were performed before the injections and 1 week, 1 month, and 3 months after the injections as well. RESULTS No significant toxicity was determined after injection in terms of the clinical examination methods in all eyes. Cataracts were observed in 27.7% (5/18) of the eyes in the study group. All cataracts in 5 eyes disappeared at the end of three months. In tonometry, no value out of the normal range of rabbits (17.5 ± 3.1 mmHg) was observed. No toxicity sign was observed at electrophysiological and histopathological evaluations. CONCLUSION After intravitreal injection of aspirin, no significant toxicity sign was observed other than a reversible cataract. Thus, intravitreal aspirin injections may be an additional or alternative treatment option for several anterior or posterior segment ocular diseases in addition to their topical utilization.
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Affiliation(s)
- Cezmi Dogan
- a Department of Ophthalmology, Cerrahpaşa Medical Faculty , Istanbul University - Cerrahpaşa , Istanbul , Turkey
| | - Huseyin Yetik
- a Department of Ophthalmology, Cerrahpaşa Medical Faculty , Istanbul University - Cerrahpaşa , Istanbul , Turkey
| | - Osman Sevki Arslan
- a Department of Ophthalmology, Cerrahpaşa Medical Faculty , Istanbul University - Cerrahpaşa , Istanbul , Turkey
| | - Hakki Oktay Seymen
- b Department of Physiology, Cerrahpaşa Medical Faculty , Istanbul University - Cerrahpaşa , Istanbul , Turkey
| | - Oner Suzer
- c Department of Pharmacology, Cerrahpaşa Medical Faculty , Istanbul University - Cerrahpaşa , Istanbul , Turkey
| | - Ovgu Aydin
- d Department of Pathology, Cerrahpaşa Medical Faculty , Istanbul University - Cerrahpaşa , Istanbul , Turkey
| | - Burak Mergen
- a Department of Ophthalmology, Cerrahpaşa Medical Faculty , Istanbul University - Cerrahpaşa , Istanbul , Turkey
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Augustin AJ, Schmidt-Erfurth U. Verteporfin Therapy and Triamcinolone Acetonide: Convergent Modes of Action for Treatment of Neovascular Age-Related Macular Degeneration. Eur J Ophthalmol 2018; 16:824-34. [PMID: 17191188 DOI: 10.1177/112067210601600607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Choroidal neovascularization associated with age-related macular degeneration is the primary cause of blindness in the elderly in developed countries, due to a number of pathogenic effects, including angiogenesis, cell-mediated inflammation, leukocyte adhesion and extravasation, and matrix remodeling. METHODS By producing photochemical effects at the site of target tissue (lesion), photodynamic therapy (PDT) can induce vascular damage and blood flow stasis, leading to occlusion of vascularization and lesion leakage. RESULTS PDT with verteporfin (Visudyne, Novartis) has been shown to be safe and effective in reducing the risk of vision loss in patients with classic containing subfoveal CNV and occult with no classic CNV. However, in predominantly occult CNV, the treatment may be most effective in smaller lesions, and less in larger lesions. Most important, visual acuity rarely is improved. CONCLUSIONS Pilot studies and large case series suggest that a combination of PDT and intravitreal triamcinolone acetonide has the potential to improve visual outcomes and reduce the need for additional treatments. Randomized, prospective clinical trials are underway to confirm the efficacy and safety of this novel treatment modality.
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Affiliation(s)
- A J Augustin
- Department of Ophthalmology, Klinikum Karlsruhe, Karlsruhe, Germany.
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Jonas JB, Akkoyun I, Kamppeter B, Kreissig I, Degenring RF. Intravitreal Triamcinolone Acetonide for Treatment of Central Retinal Vein Occlusion. Eur J Ophthalmol 2018; 15:751-8. [PMID: 16329061 DOI: 10.1177/112067210501500615] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the effect of intravitreal triamcinolone acetonide on visual acuity and intraocular pressure in patients with central retinal vein occlusion. METHODS This prospective comparative non-randomized clinical interventional study included 32 patients (33 eyes) with central retinal vein occlusion. The study group (12 patients; 13 eyes) received an intravitreal injection of about 20 mg of triamcinolone acetonide. The control group (20 patients) did not receive any treatment. Mean follow-up was 10.1+/-8.6 months in the study group and 6.0+/-5.2 months in the control group. RESULTS In the study group, mean visual acuity increased significantly (p=0.018) from 0.11+/-0.11 preoperatively to a best visual acuity during follow-up of 0.18+/-0.15. An improvement in visual acuity by at least 2 Snellen lines and 3 Snellen lines, respectively, was found for 8 (62%) eyes and 5 (38) eyes. Visual acuity measurements determined 1 month (p=0.038) and 3 months (p=0.046) after the injection were significantly higher than the baseline values. Increase in visual acuity was higher in the non-ischemic subgroup than in the ischemic subgroup. In the control group, baseline visual acuity and best visual acuity during the followup did not vary significantly (p=0.33). Visual acuity decreased significantly (p=0.007) towards the end of the follow-up. Comparing study group and control group, gain in visual acuity was significantly (p=0.01) higher in the study group. In the study group, intraocular pressure increased significantly (p=0.018) from 14.4+/-3.9 mmHg to a mean maximal value of 21.6+/-9.2 mmHg (range, 10-44 mmHg), and re-decreased (p=0.012) towards the end of follow-up to 15.3+/-5.1 mmHg (range, 10-21 mmHg). CONCLUSIONS Intravitreal triamcinolone acetonide temporarily increases visual acuity in central retinal vein occlusion. It is accompanied by an increase in intraocular pressure.
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Affiliation(s)
- J B Jonas
- Department of Ophthalmology and Eye Hospital, Faculty for Clinical Medicine Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
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Hirani A, Grover A, Lee YW, Pathak Y, Sutariya V. Nanotechnology for Omics-Based Ocular Drug Delivery. Ophthalmology 2018. [DOI: 10.4018/978-1-5225-5195-9.ch017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Millions of people suffer from ocular diseases that impair vision and can lead to blindness. Advances in genomics and proteomics have revealed a number of different molecular markers specific for different ocular diseases, thereby optimizing the processes of drug development and discovery. Nanotechnology can increase the throughput of data obtained in omics-based studies and allows for more sensitive diagnostic techniques as more efficient drug delivery systems. Biocompatible and biodegradable nanomaterials developed through omics-based research are able to target reported molecular markers for different ocular diseases and offer novel alternatives to conventional drug therapy. In this chapter, the authors review the pathophysiology, current genomic and proteomic information, and current nanomaterial-based therapies of four ocular diseases: glaucoma, uveal melanoma, age-related macular degeneration, and diabetic retinopathy. Omics-based research can be used to elucidate specific genes and proteins and develop novel nanomedicine formulations to prevent, halt, or cure ocular diseases at the transcriptional or translational level.
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Affiliation(s)
- Anjali Hirani
- University of South Florida, USA & Virginia Tech-Wake Forest University, USA
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Elbay A, Ozdemir H, Koytak A, Melikov A. Intravitreal Dexamethasone Implant for Treatment of Serous Macular Detachment in Central Retinal Vein Occlusion. J Ocul Pharmacol Ther 2017; 33:473-479. [DOI: 10.1089/jop.2016.0187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ahmet Elbay
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Hakan Ozdemir
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Arif Koytak
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Arif Melikov
- Department of Ophthalmology, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Hirani A, Grover A, Lee YW, Pathak Y, Sutariya V. Nanotechnology for Omics-Based Ocular Drug Delivery. Oncology 2017. [DOI: 10.4018/978-1-5225-0549-5.ch013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Millions of people suffer from ocular diseases that impair vision and can lead to blindness. Advances in genomics and proteomics have revealed a number of different molecular markers specific for different ocular diseases, thereby optimizing the processes of drug development and discovery. Nanotechnology can increase the throughput of data obtained in omics-based studies and allows for more sensitive diagnostic techniques as more efficient drug delivery systems. Biocompatible and biodegradable nanomaterials developed through omics-based research are able to target reported molecular markers for different ocular diseases and offer novel alternatives to conventional drug therapy. In this chapter, the authors review the pathophysiology, current genomic and proteomic information, and current nanomaterial-based therapies of four ocular diseases: glaucoma, uveal melanoma, age-related macular degeneration, and diabetic retinopathy. Omics-based research can be used to elucidate specific genes and proteins and develop novel nanomedicine formulations to prevent, halt, or cure ocular diseases at the transcriptional or translational level.
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Affiliation(s)
- Anjali Hirani
- University of South Florida, USA & Virginia Tech-Wake Forest University, USA
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Strong S, Liew G, Michaelides M. Retinitis pigmentosa-associated cystoid macular oedema: pathogenesis and avenues of intervention. Br J Ophthalmol 2016; 101:31-37. [PMID: 27913439 PMCID: PMC5256121 DOI: 10.1136/bjophthalmol-2016-309376] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 10/31/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022]
Abstract
Hereditary retinal diseases are now the leading cause of blindness certification in the working age population (age 16–64 years) in England and Wales, of which retinitis pigmentosa (RP) is the most common disorder. RP may be complicated by cystoid macular oedema (CMO), causing a reduction of central vision. The underlying pathogenesis of RP-associated CMO (RP-CMO) remains uncertain, however, several mechanisms have been proposed, including: (1) breakdown of the blood-retinal barrier, (2) failure (or dysfunction) of the pumping mechanism in the retinal pigment epithelial, (3) Müller cell oedema and dysfunction, (4) antiretinal antibodies and (5) vitreous traction. There are limited data on efficacy of treatments for RP-CMO. Treatments attempted to date include oral and topical carbonic anhydrase inhibitors, oral, topical, intravitreal and periocular steroids, topical non-steroidal anti-inflammatory medications, photocoagulation, vitrectomy with internal limiting membrane peel, oral lutein and intravitreal antivascular endothelial growth factor injections. This review summarises the evidence supporting these treatment modalities. Successful management of RP-CMO should aim to improve both quality and quantity of vision in the short term and may also slow central vision loss over time.
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Affiliation(s)
- S Strong
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK
| | - G Liew
- Westmead Institute for Medical Research, Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - M Michaelides
- UCL Institute of Ophthalmology, University College London, London, UK.,Moorfields Eye Hospital, London, UK
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Tah V, Orlans HO, Hyer J, Casswell E, Din N, Sri Shanmuganathan V, Ramskold L, Pasu S. Anti-VEGF Therapy and the Retina: An Update. J Ophthalmol 2015; 2015:627674. [PMID: 26417453 PMCID: PMC4568374 DOI: 10.1155/2015/627674] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/28/2015] [Accepted: 07/05/2015] [Indexed: 01/31/2023] Open
Abstract
Ocular angiogenesis and macular oedema are major causes of sight loss across the world. Aberrant neovascularisation, which may arise secondary to numerous disease processes, can result in reduced vision as a result of oedema, haemorrhage, and scarring. The development of antivascular endothelial growth factor (anti-VEGF) agents has revolutionised the treatment of retinal vasogenic conditions. These drugs are now commonly employed for the treatment of a plethora of ocular pathologies including choroidal neovascularisation, diabetic macular oedema, and retinal vein occlusion to name a few. In this paper, we will explore the current use of anti-VEGF in a variety of retinal diseases and the impact that these medications have had on visual outcome for patients.
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Affiliation(s)
- Vikas Tah
- The Royal Berkshire NHS Foundation Trust, Craven Road, Reading RG1 5AN, UK
| | - Harry O. Orlans
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Jonathan Hyer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Edward Casswell
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Nizar Din
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | | | - Louise Ramskold
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
| | - Saruban Pasu
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK
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Hou XR, Miao H, Tao Y, Li XX, Wong IY. Expression of cytokines on the iris of patients with neovascular glaucoma. Acta Ophthalmol 2015; 93:e100-4. [PMID: 25041566 DOI: 10.1111/aos.12510] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Accepted: 06/15/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine the expression levels of cytokines, including growth factors, inflammatory cytokines, and cell migration associated factors on the iris from subjects with neovascular glaucoma (NVG). METHODS After receiving formal consent from 12 subjects with NVG secondary to proliferative diabetic retinopathy and 12 subjects with primary open angle glaucoma (POAG), trabeculectomy was performed and iris specimens were collected during the surgery. Each subject with NVG received intravitreal injection of bevacizumab 1 week prior to the surgery. The mRNA level of vascular endothelial growth factor, basic fibroblastic growth factor, placental-induced growth factor, interleukin-2, interleukin 6, tumour necrosis factor α, intercellular adhesion molecule 1 (ICAM-1) and integrin subunit αV were determined by real-time polymerase chain reaction. The mRNA levels were compared between the two groups. RESULTS The mRNA levels of all inflammatory cytokines and integrin subunit αV were significantly increased in the NVG group compared with POAG controls. However, the mRNA level of growth factors and ICAM-1 did not show any difference between the two groups. CONCLUSIONS Inflammatory process maybe an important cause of iris neovascularization in subjects with NVG in addition to growth factors alone. Further studies should focus on the effect of growth factors in different phases in the pathogenesis of NVG.
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Affiliation(s)
- Xian-ru Hou
- Department of Ophthalmology; Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; People's Hospital; Peking University; Beijing China
| | - Heng Miao
- Department of Ophthalmology; Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; People's Hospital; Peking University; Beijing China
| | - Yong Tao
- Department of Ophthalmology; Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; People's Hospital; Peking University; Beijing China
| | - Xiao-xin Li
- Department of Ophthalmology; Key Laboratory of Vision Loss and Restoration; Ministry of Education; Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases; People's Hospital; Peking University; Beijing China
| | - Ian Y. Wong
- Department of Ophthalmology; University of Hong Kong; Hong Kong
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Kambhampati SP, Mishra MK, Mastorakos P, Oh Y, Lutty GA, Kannan RM. Intracellular delivery of dendrimer triamcinolone acetonide conjugates into microglial and human retinal pigment epithelial cells. Eur J Pharm Biopharm 2015; 95:239-49. [PMID: 25701805 DOI: 10.1016/j.ejpb.2015.02.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/05/2015] [Accepted: 02/09/2015] [Indexed: 01/22/2023]
Abstract
Triamcinolone acetonide (TA) is a potent, intermediate-acting, steroid that has anti-inflammatory and anti-angiogenic activity. Intravitreal administration of TA has been used for diabetic macular edema, proliferative diabetic retinopathy and exudative age-related macular degeneration (AMD). However, the hydrophobicity, lack of solubility, and the side effects limit its effectiveness in the treatment of retinal diseases. In this study, we explore a PAMAM dendrimer-TA conjugate (D-TA) as a potential strategy to improve intracellular delivery and efficacy of TA to target cells. The conjugates were prepared with a high drug payload (∼ 21%) and were readily soluble in saline. Compared to free TA, D-TA demonstrated a significantly improved toxicity profile in two important target [microglial and human retinal pigment epithelium (RPE)] cells. The D-TA was ∼ 100-fold more effective than free TA in its anti-inflammatory activity (measured in microglia), and in suppressing VEGF production (in hypoxic RPE cells). Dendrimer-based delivery may improve the efficacy of TA towards both its key targets of inflammation and VEGF production, with significant clinical implications.
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Affiliation(s)
- Siva P Kambhampati
- Center for Nanomedicine, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Manoj K Mishra
- Center for Nanomedicine, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Panagiotis Mastorakos
- Center for Nanomedicine, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yumin Oh
- Center for Nanomedicine, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Gerard A Lutty
- Center for Nanomedicine, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rangaramanujam M Kannan
- Center for Nanomedicine, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.
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Kuppermann BD, Zacharias LC, Kenney MC. Steroid differentiation: the safety profile of various steroids on retinal cells in vitro and their implications for clinical use (an American Ophthalmological Society thesis). TRANSACTIONS OF THE AMERICAN OPHTHALMOLOGICAL SOCIETY 2014; 112:116-41. [PMID: 25646032 PMCID: PMC4311675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To determine if potentially viable alternatives to the clinical use of intravitreal triamcinolone acetonide should be considered based on a comparative assessment of the in vitro effects of five commercially available corticosteroids. We hypothesized that dexamethasone, betamethasone, methylprednisolone, loteprednol etabonate, and fluocinolone acetonide, at clinically relevant doses, may show different levels of in vitro cytotoxicity to retinal cells. METHODS Cultures of human retinal pigment epithelial cells (ARPE-19) and rat embryonal neurosensory precursor retinal cells (R28) were treated with dexamethasone, betamethasone, methylprednisolone, loteprednol, or fluocinolone acetonide. Cell viability as a measure of cell death was determined by trypan blue dye exclusion assay. The mechanical effect of drug crystals was evaluated by solubilizing the steroid formulations. Mitochondrial dehydrogenase and membrane potential were assessed to measure cell damage. RESULTS Betamethasone, loteprednol, and methylprednisolone, in commercially available forms, caused significant cytotoxic changes to retinal cells in vitro at clinically relevant doses. This effect was less pronounced with solubilized betamethasone. Dexamethasone at concentrations up to 5 times the clinical dose of free drug injections and 1000 times greater than a drug implant did not cause decreased cell viability. Fluocinolone acetonide at doses 1000 times higher than observed with drug delivery systems showed no cytotoxic effect. CONCLUSIONS Betamethasone, loteprednol, and methylprednisolone exhibited cytotoxicity at clinically relevant doses and do not appear to be good therapeutic options for intravitreal use. In comparison, dexamethasone and fluocinolone acetonide, which exhibited fewer cytotoxic effects than other steroids, may be potentially viable alternatives to triamcinolone acetonide for clinical use.
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Affiliation(s)
- Baruch D Kuppermann
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California Irvine, Irvine, California
| | | | - M Cristina Kenney
- Gavin Herbert Eye Institute, Department of Ophthalmology, University of California Irvine, Irvine, California
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Barge S, Rothwell R, Sepúlveda P, Agrelos L. Intravitreal and subtenon depot triamcinolone as treatment of retinitis pigmentosa associated cystoid macular edema. Case Rep Ophthalmol Med 2013; 2013:591681. [PMID: 24455364 PMCID: PMC3885263 DOI: 10.1155/2013/591681] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Accepted: 11/25/2013] [Indexed: 12/02/2022] Open
Abstract
We present a case of retinitis pigmentosa (RP) related cystoid macular edema (CME) refractory to oral acetazolamide and topical ketorolac that was treated with intravitreal and subtenon depot triamcinolone. A 32-year-old male with RP presented with complaints of bilateral decrease in visual acuity. His best-corrected visual acuity (BCVA) was 20/50 in the right eye and 20/100 in the left eye. After being informed of the available treatment options, the patient received bilateral intravitreal injection triamcinolone. The patient's BCVA improved to 20/40 in the right eye and 20/50 in the left eye and the CME was resorbed. However, 5 months after the injection in the left eye and two months in the right eye, visual acuity decreased due to recurrence of CME. We performed a second intravitreal injection in the left eye with improvement of visual and anatomic results, but we observed a recurrence of CME. Afterwards, we treated the patient with subtenon depot triamcinolone in both eyes, with the result that there was no recurrence after 4 months in OD or after 3 months in OS. We conclude that intravitreal and subtenon depot triamcinolone appear to provide at least temporary benefit in refractory CME as regards the improvement of visual acuity.
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Affiliation(s)
- Sidnei Barge
- Department of Ophthalmology, Vila Nova Gaia/Espinho Hospital, Rua Conceição Fernandes, 4434-502 Vila Nova Gaia, Portugal
| | - Renata Rothwell
- Department of Ophthalmology, Vila Nova Gaia/Espinho Hospital, Rua Conceição Fernandes, 4434-502 Vila Nova Gaia, Portugal
| | - Paula Sepúlveda
- Department of Ophthalmology, Vila Nova Gaia/Espinho Hospital, Rua Conceição Fernandes, 4434-502 Vila Nova Gaia, Portugal
| | - Luís Agrelos
- Department of Ophthalmology, Vila Nova Gaia/Espinho Hospital, Rua Conceição Fernandes, 4434-502 Vila Nova Gaia, Portugal
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Salvatore S, Fishman GA, Genead MA. Treatment of cystic macular lesions in hereditary retinal dystrophies. Surv Ophthalmol 2013; 58:560-84. [DOI: 10.1016/j.survophthal.2012.11.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 11/14/2012] [Accepted: 11/20/2012] [Indexed: 12/25/2022]
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Shirasawa M, Sonoda S, Terasaki H, Arimura N, Otsuka H, Yamashita T, Uchino E, Hisatomi T, Ishibashi T, Sakamoto T. TNF-α disrupts morphologic and functional barrier properties of polarized retinal pigment epithelium. Exp Eye Res 2013; 110:59-69. [DOI: 10.1016/j.exer.2013.02.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 02/07/2013] [Accepted: 02/14/2013] [Indexed: 01/13/2023]
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Senturk F, Ozdemir H, Karacorlu M, Karacorlu SA, Uysal O. Retinal sensitivity improvement after intravitreal triamcinolone acetonide injection for macular edema secondary to branch retinal vein occlusion. Indian J Ophthalmol 2013; 61:3-7. [PMID: 23275213 PMCID: PMC3554992 DOI: 10.4103/0301-4738.105048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Purpose: To evaluate the effect of intravitreal triamcinolone acetonide (IVTA) on retinal sensitivity in cases of macular edema(ME) secondary to branch retinal vein occlusion (BRVO). Materials and Methods: Total of 14 eyes of 14 cases of BRVO were included in this prospective study. In each eye, at baseline and 1, 3, and 6 months after IVTA injection, logMAR visual acuity, central 4° retinal sensitivity by MP-1 microperimetry, and optical coherence tomography foveal thickness were assessed. Results: Cases ages ranged from 60 to 79 years (mean 68 ± 8 years). At 1, 3, and 6 months, the logMAR visual acuity had increased from 0.71 ± 0.21 to 0.42 ± 0.21, 0.46 ± 0.30, and 0.46 ± 0.27; the mean foveal thickness had decreased from 540 ± 88 μm to 254 ± 51 μm, 288 ± 84 μm, and 280 ± 91 μm; and the mean retinal sensitivity had increased from 4.7 ± 2.5 dB to 7.9 ± 2.7 dB, 8.2 ± 3.6 dB, and 8.3 ± 4.6 dB, respectively. Conclusion: In eyes with ME secondary to BRVO, IVTA injections result in a significant increase in not only the visual acuity but also the central 4° retinal sensitivity in 6 months follow-up.
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Kiernan DF, Mieler WF. Intraocular corticosteroids for posterior segment disease: 2012 update. Expert Opin Pharmacother 2012; 13:1679-94. [PMID: 22783878 DOI: 10.1517/14656566.2012.690736] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Diabetic macular edema (DME), cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO) and uveitis are responsible for severe visual impairment worldwide. In some patients with these conditions, treatment with intraocular corticosteroids may be beneficial. Although off-label use of these agents has occurred for many years, novel agents including preservative-free and sustained-release intravitreal implants are currently being studied in clinical trials (CTs). AREAS COVERED This paper reviews the use of CTs for vitreoretinal (VR) diseases including choroidal neovascularization, CME, DME, RVO and posterior uveitis. It also discusses the use of corticosteroids for treating VR disease, including dexamethasone, fluocinolone acetonide, intravitreal implants and triamcinolone acetonide. EXPERT OPINION Used alone, intravitreal corticosteroids may benefit disorders such as DME, RVO and uveitis compared with standard therapy. Cases of exudative AMD non-responsive to standard treatment may benefit from combination therapy, including usage of intravitreal corticosteroid injections. Intraoperative use of these agents may aid visualization of retinal structures. Sustained-release intraocular implants have been approved for posterior uveitis and RVO associated with macular edema. In spite of this, most intraocular corticosteroids have a limited duration of action along with significant side effects, including cataract and glaucoma. Currently, intravitreal corticosteroid usage for DME is considered off-label.
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Affiliation(s)
- Daniel F Kiernan
- Ophthalmic Consultants of Long Island, Rockville Centre, NY, USA
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Yilmaz T, Cordero-Coma M, Federici TJ. Pharmacokinetics of triamcinolone acetonide for the treatment of macular edema. Expert Opin Drug Metab Toxicol 2011; 7:1327-35. [PMID: 21790508 DOI: 10.1517/17425255.2011.606215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The use of intravitreal triamcinolone acetonide (TA) for the treatment of various types of macular edema has been widespread, particularly for the last decade. Currently, there is a scant amount of evidence-based literature evaluating the pharmacokinetic profile of TA despite clinical data showing the efficacy of intravitreal TA for multiple forms of macular edema. AREAS COVERED This paper is an extensive review of human and experimental studies published on the pharmacokinetics of TA for the treatment of macular edema. The literature search was conducted via OVID, TRIP Database and EMBASE, up to April 2011. EXPERT OPINION The pharmacokinetic profile of TA is unpredictable and the agent has a time-limited therapeutic action due to its relatively short half-life. This has led to the need for repeated injections. Future research should investigate the pharmacokinetic profiles of TA when administered intravitreally, as well as through alternate routes in more robust studies.
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Affiliation(s)
- Taygan Yilmaz
- Stony Brook University, Department of Ophthalmology, 33 Research Way, East Setauket, NY 11733, USA.
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Steinle N, Barakat M, Moshfeghi D, Kaiser PK. Radiation therapy in the treatment of exudative age-related macular degeneration. EXPERT REVIEW OF OPHTHALMOLOGY 2011. [DOI: 10.1586/eop.11.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
INTRODUCTION The Ozurdex(®) (Allergan Inc., Irvine, CA, USA) dexamethasone drug delivery system (DDS) was recently developed as a biodegradable intravitreal implant to provide sustained delivery of 700 μg of preservativefree dexamethasone to the retina and vitreous, and is approved by the United States Food and Drug Administration (FDA) for the treatment of macular edema associated with retinal vein occlusion, as well as for noninfectious posterior uveitis. This review summarizes the rationale behind the development of the dexamethasone DDS, evidence for its use in various clinical scenarios, and compares its efficacy to other available treatment options. METHODS Published data regarding the dexamethasone DDS as well as unpublished data that has been presented at national meetings were reviewed. RESULTS The dexamethasone DDS has evidence for efficacy in multiple clinical situations, including macular edema associated with retinal vein occlusion (RVO), macular edema associated with uveitis or Irvine-Gass syndrome, diabetic macular edema in vitrectomized eyes, persistent macular edema, noninfectious vitritis, and as adjunctive therapy for age-related macular degeneration. Safety concerns include cataract formation and intraocular pressure elevation that is most often temporary and amenable to medical management. CONCLUSIONS The dexamethasone DDS is one of the most recent additions to the armamentarium against macular edema, and is intriguing for its potency, dose consistency, potential for extended duration of action, and favorable safety profile. Early evidence shows clinical utility for several conditions, the most well established being for macular edema associated with RVO. Future studies and, in particular, head-to-head comparisons with other treatment modalities will elucidate the precise role for the dexamethasone DDS in clinical practice.
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Forte R, Cennamo G, Finelli M, Cesarano I, D'Amico G, De Crecchio G, Cennamo G. Intravitreal triamcinolone, bevacizumab and pegaptanib for occult choroidal neovascularization. Acta Ophthalmol 2010; 88:e305-10. [PMID: 20946332 DOI: 10.1111/j.1755-3768.2010.02021.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate best-corrected visual acuity (BCVA) and foveal thickness (FT) changes in occult subfoveal choroidal neovascularization (CNV) from age-related macular degeneration (AMD) after intravitreal bevacizumab (IVB, 1.25 mg/0.05 ml), pegaptanib (IVP, 0.3 mg/0.09 ml) and triamcinolone acetonide (IVTA, 4 mg/0.1 ml) injected on an as needed basis. METHODS Retrospective, interventional, comparative study. BCVA (Early Treatment Diabetic Retinopathy Study LogMAR) and FT by optical coherence tomography (OCT) were evaluated during 12 months from first treatment. Patients were retreated if signs of neovascular activity were still present on angiography or OCT. RESULTS Forty-eight eyes received IVB, 43 eyes received IVP, 52 eyes received IVTA. BCVA and FT at baseline were 1.22 ± 0.49 LogMAR and 410.2 ± 41.83 μm in the IVB group, 1.25 ± 0.43 LogMAR and 452.3 ± 44.83 μm in the IVP group and 1.31 ± 0.4 LogMAR and 456.6 ± 48.27 μm in the IVTA group. BCVA and FT improved in the three groups during follow-up. A significantly greater improvement of BCVA was present at month-3, month-6 and at month-12 in the IVB and IVP groups (p = 0.01). Improvement of FT was greater in the IVTA group at month-3 (p = 0.02), while it was greater in the anti-Vascular Endothelial Growth Factor (VEGF) groups at month-6 and month-12 (p = 0.01). A postoperative increase of intraocular pressure was detected in 9/52 (17.3%) eyes treated with IVTA, and in two cases it was resistant to topical therapy. CONCLUSION Intravitreal injection of anti-VEGF drugs administered on an as needed basis for AMD-related occult CNVs provided functional and anatomic improvement during 12 months of follow-up.
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Abstract
The retinal pigment epithelium is an important barrier to drug transport as well as contributing to the normal functioning of the photoreceptors. The contributions of glial cells in the retina to the maintenance and development of this barrier is important. There is evidence that retinal secreted factors play a role in the induction and maintenance of the outer blood retinal barrier. One possible source of such factors are the retinal glial cells, astrocytes and Müller cells, which may influence tight junction formation and maturation. The aim of this study was to examine the changes in the trans-epithelial resistance (TER), as a measure of barrier integrity, on cell lines of epithelial origin (ECV304 and ARPE-19) following co-culture with glial cell lines (C6 and MIO-M1) or with the addition of medium conditioned by these cells. One cell line, ECV304, showed a significant increase in the TER in response to glial secreted factors whilst ARPE-19 did not. This finding suggests that ECV304 responds well to glial factors and may be useful for further studies of the factors that affect tight junction formation through glial cell induction in vitro.
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Affiliation(s)
- Paul A Constable
- Department of Optometry and Visual Science, Henry Wellcome Laboratories for Visual Sciences, City University, Northampton Square, London ECIV OHB, UK.
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Chan A, Blumenkranz MS, Wu KHC, Wang G, Berker N, Parast LM, Sanislo SR. Photodynamic therapy with and without adjunctive intravitreal triamcinolone acetonide: a retrospective comparative study. Ophthalmic Surg Lasers Imaging Retina 2010; 40:561-9. [PMID: 19928721 DOI: 10.3928/15428877-20091030-05] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2008] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare photodynamic therapy (PDT) with and without adjunctive intravitreal triamcinolone acetonide (IVTA) in the treatment of choroidal neovascularization secondary to age-related macular degeneration. PATIENTS AND METHODS Sixty-six eyes received PDT with IVTA and 73 eyes received PDT only. Outcome measures included changes in visual acuity and greatest linear dimension (GLD), the presence of angiographic leakage, the re-treatment rate, and adverse events. RESULTS Patients treated with PDT with IVTA had reduced mean GLD compared to patients treated with PDT only at all study time points (3 [P = .0049], 6 [P = .003], and 12 [P = .05] months). Forty-four percent of patients in the PDT with IVTA group and 22% of patients in the PDT only group achieved angiographic closure at 3 months (P = .027). There were no significant differences in the final visual acuity outcome or the re-treatment rate between the two groups. CONCLUSION PDT with IVTA therapy has a favorable outcome on GLD. There is a modest improvement in visual acuity with PDT with IVTA therapy, which diminishes over time.
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Affiliation(s)
- Annie Chan
- Department of Ophthalmology, Stanford University Medical Center, Stanford University, Menlo Park, CA 94025, USA
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Abstract
BACKGROUND Diabetic macular edema (DME), cystoid macular edema (CME), age-related macular degeneration (AMD), retinal vascular occlusion (RVO) and uveitis are responsible for severe visual impairment worldwide. In some patients with these conditions, treatment with intraocular corticosteroids may be beneficial. Although off-label use of these agents has occurred for many years, novel agents including preservative-free and sustained-release intravitreal implants are currently being studied in clinical trials (CTs). OBJECTIVE To review the use of intraocular corticosteroids. METHODS Literature review. RESULTS Used alone, intravitreal corticosteroids may benefit disorders such as DME, RVO and uveitis compared with standard therapy or observation. Patients with AMD may benefit more from combination treatment with photodynamic therapy, intravitreal corticosteroid and intravitreal anti-VEGF injections. Intraoperative use of these agents may assist in visualization and manipulation of fine retinal structures. Sustained-release intraocular implants have been approved for severe posterior uveitis, and have shown benefits in ongoing CTs. CONCLUSION Although intraocular corticosteroid injections have a limited duration of action requiring frequent re-treatment, and significant side effects including cataract and glaucoma development, intraocular injections may be of benefit in certain ocular disorders. Corticosteroid implants are emerging as potential treatments for macular edema due to uveitis, DME or RVO.
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Affiliation(s)
- Daniel F Kiernan
- Department of Ophthalmology & Visual Sciences, University of Illinois at Chicago, Illinois 60612, USA
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Propes B, Poon D, Do DV. Role of intraocular steroids for the treatment of diabetic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2009. [DOI: 10.1586/eop.09.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bandello F, Pognuz R, Polito A, Pirracchio A, Menchini F, Ambesi M. Diabetic macular edema: classification, medical and laser therapy. Semin Ophthalmol 2009; 18:251-8. [PMID: 15513012 DOI: 10.1080/08820530390895262] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE to propose and describe a new classification of diabetic macular edema (DME) based on its etiopathogenetic features and to present efficacy and safety data on medical and laser treatments currently used and under investigation. METHODS available literature on DME has been reviewed and information provided by contact lens biomicroscopy, fluorescein angiography and optical coherence tomomography has been combined; published data from trials and reports investigating effectiveness of medical and laser treatments were also analyzed. RESULTS DME was classified according to its main etiopathogenetic components: prevalently retinovascular, tractional and with taut attached posterior hyaloid, each of them having peculiar aspects on fundus, angiographic and tomographic examination. Focal laser treatment remains the only effective intervention, as shown by a large randomized controlled trial, but new less-invasive photocoagulation strategies (i.e., light laser photocoagulation and subthreshold micropulse diode laser) as well as pharmacological approaches (i.e., antioxidants, PKC inhibitors, aldose-reductase and AGE inhibitors, VEGF inhibitors, intravitreal triamcinolone) are emerging. CONCLUSIONS based on our review a classification of DME was developed that may prove useful in making the appropriate treatment decision; the new laser and pharmacological treatments currently investigated are promising and need to be confirmed by large, controlled clinical trials.
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Affiliation(s)
- F Bandello
- Department of Ophthalmology, University of Udine, 33100 Udine, Italy.
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Fialho SL, Rêgo MB, Siqueira RC, Jorge R, Haddad A, Rodrigues AL, Maia-Filho A, Silva-Cunha A. Safety and Pharmacokinetics of an Intravitreal Biodegradable Implant of Dexamethasone Acetate in Rabbit Eyes. Curr Eye Res 2009; 31:525-34. [PMID: 16769612 DOI: 10.1080/02713680600719036] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The treatment of vitreoretinal diseases is limited and, nowadays, new drug delivery approaches have been reported in order to increase drug bioavailability. The objective of the current study was to determine the pharmacokinetic profile of a biodegradable dexamethasone acetate implant inserted into the vitreous of rabbits and to evaluate its potential signs of toxicity to the rabbits' eyes. The results showed that the intravitreous drug concentration remained within the therapeutic range along the 8-week period of evaluation. The system under study was not toxic to the normal rabbit retina, and no significant increase in intraocular pressure was observed.
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Affiliation(s)
- S L Fialho
- Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Chen YH, Chen JT, Chien MW, Chang YH, Chen CL. Subretinal fluid from rhegmatogenous retinal detachment and blood induces the expression of ICAM-1 in the human retinal pigment epithelium (ARPE-19) in vitro. Eye (Lond) 2009; 24:354-60. [DOI: 10.1038/eye.2009.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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McAllister IL, Vijayasekaran S, Chen SD, Yu DY. Effect of triamcinolone acetonide on vascular endothelial growth factor and occludin levels in branch retinal vein occlusion. Am J Ophthalmol 2009; 147:838-46, 846.e1-2. [PMID: 19211093 DOI: 10.1016/j.ajo.2008.12.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 12/01/2008] [Accepted: 12/03/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the molecular mechanism by which triamcinolone acetonide (TA) may reduce edema in a porcine model of branch retinal vein occlusion (BRVO). DESIGN Animal study. METHOD After baseline ophthalmoscopic examination and fundus photography, a BRVO was created photothrombotically in each eye of 6 pigs, using argon green photocoagulation and intravenous Rose Bengal. Following this, the left eye was injected intravitreally with 4 mg/0.1 ml TA. After 11 weeks, the eyes were re-examined. Fluorescein angiography, in addition to ophthalmoscopy and fundus photography, was performed. Following sacrifice of the animals, the eyes were enucleated and processed. The distribution of vascular endothelial growth factor (VEGF), occludin, and glial fibrillary acidic protein (GFAP) were localized by immunofluorescence cytochemistry on 10 microm frozen retinal sections of TA-treated and untreated eyes. RESULTS Retinal VEGF levels were significantly lower in the TA-treated eyes as compared with the untreated eye (P = .002). Conversely occludin levels were significantly higher in the treated eye (P = .026). There was also a significant reduction in GFAP immunoreactivity in the Muller cells of the treated eyes (P = .015) with no statistical significance in the astrocytes (P = .065). CONCLUSION Intravitreal TA down regulates VEGF, which may prevent a decrease in occludin and also inhibits an increase in GFAP expression in Muller cells. These events may contribute to a reduction in the blood retinal barrier breakdown that occurs in BRVO and promote resolution of the associated retinal edema.
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Affiliation(s)
- Ian L McAllister
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia.
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Triamcinolone acetonide prevents oxidative stress-induced tight junction disruption of retinal pigment epithelial cells. Graefes Arch Clin Exp Ophthalmol 2009; 247:641-9. [PMID: 19189116 DOI: 10.1007/s00417-009-1041-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 12/23/2008] [Accepted: 01/12/2009] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Oxidative stress is known to disrupt the integrity of retinal pigment epithelium (RPE) tight junctions. The goal of this study is to evaluate the effect of triamcinolone acetonide (TA) on the junctional integrity of RPE under oxidative stress and to identify the underlying mechanisms. METHODS Second passage porcine RPE cells were cultured on 6-well membrane inserts until 4 weeks after reaching confluence. Cells were incubated with TA (10(-5) M) for 30 min. FITC-containing medium was added to the upper chamber (cell's apical side). The cells were then challenged with 1 mM Hydrogen Peroxide (H(2)O(2)). After 5 h, the fluorescence intensity of the medium from lower chamber (cell's basolateral side) was measured using a fluorescence spectrofluorophotometer. This transepithelial flux of FITC-dextran was measured until the 21st day. The immunolocalization of occludin and F-actin was examined with fluorescence microscope. Reduced glutathione (GSH)/oxidized glutathione (GSSG) ratio was determined by a colorimetric assay kit. RESULTS Non-lethal oxidative stress by H(2)O(2) increased transepithelial flux of FITC-dextran significantly. TA inhibited this increase and preserved the lower flux through the whole experimental period. This permeability change by H(2)O(2) was reversible and recovered to the normal level within 3 weeks. In immunohistological study, H(2)O(2) reduced linear occludin staining at the cell border and increased actin stress fibers. TA prevented H(2)O(2)-induced disruption of junctional assembly of occludin and F-actin. Glutathione assay demonstrated that intracellular GSH/GSSG ratio decreased significantly with H(2)O(2), while TA preserved this ratio by up-regulating GSH synthesis. CONCLUSIONS TA has a protective effect against oxidative stress-induced disruption of RPE tight junction by preserving cellular redox state.
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Ali TK, El-Remessy AB. Diabetic Retinopathy: Current Management and Experimental Therapeutic Targets. Pharmacotherapy 2009; 29:182-92. [DOI: 10.1592/phco.29.2.182] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Maia OO, Takahashi BS, Costa RA, Scott IU, Takahashi WY. Combined laser and intravitreal triamcinolone for proliferative diabetic retinopathy and macular edema: one-year results of a randomized clinical trial. Am J Ophthalmol 2009; 147:291-297.e2. [PMID: 18929352 DOI: 10.1016/j.ajo.2008.08.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 08/17/2008] [Accepted: 08/18/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate laser combined with intravitreal triamcinolone acetonide (IVTA) for the management of patients with proliferative diabetic retinopathy (PDR) and clinically significant macular edema (CSME). DESIGN Randomized clinical trial. METHODS settings: Single center. study population: Twenty-two patients with bilateral treatment-naïve moderate PDR and CSME. intervention: Laser (panretinal and macular) photocoagulation was performed in each eye, followed by IVTA in one randomly assigned eye. Best-corrected visual acuity (BCVA), fundus photography, and optical coherence tomography were performed at baseline and at months 1, 3, 6, 9, and 12. main outcome measures: Changes in BCVA, central macular thickness (CMT), and total macular volume (TMV). RESULTS The mean logarithm of the minimal angle of resolution (logMAR) BCVA improved significantly, and mean CMT and TMV were significantly reduced in the IVTA group compared with the laser-only group (controls) at all study follow-up visits (P < .001). The mean logMAR BCVA (Snellen equivalent) was 0.44 (20/50(-2)) for the IVTA group and 0.38 (20/50(+1)) for the controls at baseline, and 0.12 (20/25(-1)) for the IVTA group and 0.32 (20/40(-1)) for the controls at 12 months (P < .001). The mean CMT and TMV were, respectively, 360 microm and 8.59 mm(3) for the IVTA group and 331 microm and 8.44 mm(3) for the controls at baseline, and 236 microm and 7.32 mm(3) for the IVTA group and 266 microm and 7.78 mm(3) for the controls at 12 months (P < .001). CONCLUSIONS The combination of laser photocoagulation with IVTA was associated with improved BCVA and decreased CMT and TMV when compared with laser photocoagulation alone for the treatment of moderate PDR with CSME.
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Affiliation(s)
- Otacilio O Maia
- Department of Ophthalmology, Hospital São Rafael, Monte Tabor Foundation, Salvador, BA, Brazil.
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Funatsu H, Noma H, Mimura T, Eguchi S, Hori S. Association of vitreous inflammatory factors with diabetic macular edema. Ophthalmology 2009; 116:73-9. [PMID: 19118698 DOI: 10.1016/j.ophtha.2008.09.037] [Citation(s) in RCA: 331] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2008] [Revised: 09/17/2008] [Accepted: 09/23/2008] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the association between vitreous inflammatory factors and the severity of diabetic macular edema (DME). DESIGN Retrospective case-control study. PARTICIPANTS Fifty-three patients with DME, 15 patients with nondiabetic ocular disease, and 8 diabetic patients without retinopathy. METHODS Vitreous fluid samples were obtained during vitreoretinal surgery, and the levels of vascular endothelial growth factor (VEGF), intercellular adhesion molecule (ICAM)-1, interleukin (IL)-6, monocyte chemotactic protein (MCP)-1, and pigment epithelium-derived factor (PEDF) were measured by enzyme-linked immunosorbent assay. Multivariate analysis was performed to assess the association of these factors with the severity of DME. MAIN OUTCOME MEASURES Vitreous fluid levels of inflammatory factors. RESULTS Vitreous fluid levels of VEGF, ICAM-1, IL-6, and MCP-1 were significantly higher in patients with DME than in nondiabetic patients (P<0.05, all respectively) or diabetic patients without retinopathy (P<0.05, all respectively). In contrast, the PEDF level was significantly lower in patients with DME than in nondiabetic patients (P<0.05) or diabetic patients without retinopathy (P<0.05). Vitreous levels of VEGF, ICAM-1, IL-6, and MCP-1 were significantly higher in patients with hyperfluorescent DME than in those with minimally fluorescent DME (P = 0.0018, P = 0.0022, P = 0.0032, and P = 0.0053, respectively). Conversely, the vitreous level of PEDF was significantly lower in hyperfluorescent DME than in minimally fluorescent DME (P = 0.0134). Vitreous levels of VEGF, ICAM-1, IL-6, MCP-1, and PEDF were significantly correlated with the retinal thickness at the central fovea (P<0.0001, P<0.0001, P = 0.0282, P = 0.0009, and P = 0.0466, respectively). VEGF and ICAM-1 had a stronger influence on the severity of DME than the other factors (P = 0.0004 and P = 0.0372, respectively). CONCLUSIONS Vitreous fluid levels of VEGF, ICAM-1, IL-6, MCP-1, and PEDF were related to retinal vascular permeability and the severity of DME. VEGF and ICAM-1 had a stronger influence than the other factors. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Hideharu Funatsu
- Department of Ophthalmology, Yachiyo Medical Center, Tokyo Women's Medical University, Yachiyo, Japan.
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FAGHIHI HOOSHANG, TAHERI ARASH, FARAHVASH MOHAMMADSADEGH, ESFAHANI MOHAMMADRIAZI, RAJABI MOHAMMADTAHER. INTRAVITREAL TRIAMCINOLONE ACETONIDE INJECTION AT THE END OF VITRECTOMY FOR DIABETIC VITREOUS HEMORRHAGE. Retina 2008; 28:1241-6. [DOI: 10.1097/iae.0b013e31817d5be3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Wurm A, Iandiev I, Hollborn M, Wiedemann P, Reichenbach A, Zimmermann H, Bringmann A, Pannicke T. Purinergic receptor activation inhibits osmotic glial cell swelling in the diabetic rat retina. Exp Eye Res 2008; 87:385-93. [DOI: 10.1016/j.exer.2008.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 06/23/2008] [Accepted: 07/09/2008] [Indexed: 10/21/2022]
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Wang K, Wang Y, Gao L, Li X, Li M, Guo J. Dexamethasone inhibits leukocyte accumulation and vascular permeability in retina of streptozotocin-induced diabetic rats via reducing vascular endothelial growth factor and intercellular adhesion molecule-1 expression. Biol Pharm Bull 2008; 31:1541-6. [PMID: 18670086 DOI: 10.1248/bpb.31.1541] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intravitreal injection of corticosteroid has been used to treat diabetic macular edema, however, the exact mechanism remains unknown. In the present experiment, four weeks after streptozotocin administration, intravitreal injection of dexamethasone (50 microg/10 microl) was performed. After 2 d injection, we investigated the effect of dexamethasone on leukocyte accumulation, vascular permeability and the expression of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1) in streptozotocin-diabetic rats. Accumulated leukocytes were counted in vivo by acridine orange leukocyte fluorography, the retinal vascular permeability was measured by the Evans blue assay. The mRNA and protein level of VEGF and ICAM-1 were analyzed with real-time quantitative polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) respectively. Dexamethasone downregulated VEGF and ICAM-1 expression in diabetic rats which correlated with its effect on leukocytes accumulation and retinal vascular permeability. The present data revealed that dexamethasone may inhibit retinal accumulation and leukostasis accumulation and vascular permeability through its blockage on VEGF and ICAM-1 expression.
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Affiliation(s)
- Kang Wang
- Department of Ophthalmology, Beijing Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
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COMBINATION TREATMENT WITH REDUCED-FLUENCE PHOTODYNAMIC THERAPY AND INTRAVITREAL INJECTION OF TRIAMCINOLONE FOR SUBFOVEAL CHOROIDAL NEOVASCULARIZATION IN MACULAR DEGENERATION. Retina 2008; 28:789-93. [DOI: 10.1097/iae.0b013e31817082d7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lee SY, Lee HG, Chung HW, Yoon YH, Kim JG. Efficacy of intravitreal triamcinolone acetonide for eyes with postvitrectomy diabetic vitreous hemorrhage. KOREAN JOURNAL OF OPHTHALMOLOGY 2008; 21:208-12. [PMID: 18063884 PMCID: PMC2629885 DOI: 10.3341/kjo.2007.21.4.208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of intravitreal triamcinolone acetonide (IVT) for the management of postvitrectomy diabetic vitreous hemorrhage. Methods The authors conducted a retrospective study of patients with postvitrectomy diabetic vitreous hemorrhage who were administered 4 mg (0.1 cc) of triamcinolone acetonide ophthalmic suspension. Ocular history, adverse events, BCVA, intraocular pressure, external eye examination, slit-lamp biomicroscopy, fundus examination, B-scan ultrasonography, and fundus photography were assessed on day 1, weeks 1, 2, and 4 and months 2 and 3. Results There were 19 eyes of 18 consecutive patients with mean follow-up after IVT injection of 28 weeks. Of the 19 eyes, 17 eyes (89%) experienced clearing of vitreous hemorrhage within 1 to 5 weeks (mean, 1.7 weeks) with visible triamcinolone precipitates along with blood clot in the inferior aspect of fundus. Of these 17 eyes, 12 eyes (63%) maintained vitreous hemorrhage-free condition at last follow-up with a mean visual acuity of 20/63 (range, 20/320 20/25), whereas 5 (29%) developed recurrent vitreous hemorrhage after clearing of vitreous hemorrhage. Vitreous hemorrhage was not cleared in 2 eyes, which required surgical procedures. Conclusions IVT injection may be beneficial for clearing recurrent postvitrectomy Diabetic Vitreous Hemorrhage.
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Affiliation(s)
- Sun Young Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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